痢分寒热各相争，张氏（号心在，近时人着《张氏医参》）伏邪论最精，肠热（肠喜热，日受
热而伏为病根）胃寒（胃喜寒，日受寒而伏为病根）标（标热）本（本寒）异，暑过（炎暑已退，寒气欲动）秋
至
（新秋初至，余热犹燃）序时更，理中（汤）姜克贪凉病，加味（煎汤加大）黄令郁火清，初患尚轻休语
此，止从芍药汤定权衡。
发热如焚痢可愁，当归四逆（汤）探源流，小柴（胡汤）治呕兼寒热，仓廪汤中再讲求。
噤口垂危亦可医，大承（气汤）神妙少人知，芩连葛草（葛根，黄连，黄芩，甘草汤）相需用，夺
出三关在片时。
真人养脏（汤）直肠需（水谷直下不停，）间用香连（丸）止下趋，仲景桃花（汤）春有脚？个中识得反
三隅。
阴虚下痢、发热脓血稠粘及休息痢，用驻车丸。
千金传下驻车丸，两半归连重一般，三两阿胶姜一两，阴虚久痢得灵丹。
阿胶（三两） 黄连 当归（各一两半） 干姜(炒，一两)醋煮阿胶为丸，每服四、五十丸，昼夜
三服，米饮下。“三车”运精、气、神，分治三焦，以调适阴阳。此因阳热过旺，阴精受伤
，故用黄连以驻鹿车之骤，干姜以策牛车之疲，阿胶以挽牛车之陷，当归以和精气神之散乱
也。张石顽此注甚超，全录之。
奇恒痢。张隐庵曰∶“病生于外感，内伤，人所共知，而奇恒之病，知之者鲜矣。奇恒
者，异于恒常也。即以奇恒之下利而言，乃三阳并至，三阴莫当，积并则为惊，风病起疾，至
如砺，九窍皆寒，阳气旁溢，嗌干喉塞。痛并于阴，则上下无常，薄为肠 。其脉缓
小迟
涩，血温身热死，热见七日死。盖因阳气偏剧，阴气受伤，是以脉小沉涩。此证急宜大承气
汤泻阳养阴，缓则不救。医者不知奇恒之因，见脉气和缓，而用平易之剂，此又何异于毒药
乎。予故曰∶服平和之药而愈者，原不死之病，勿药亦可，服平和汤而后成不救者，医之罪
也。
痢疾分为寒证和热证，二者性质不同。张氏（号心在，近代人，著有《张氏医参》）关于伏邪的理论最为精辟。其病机为肠中蕴热（肠道本性喜温，若长期受热邪潜伏则成为发病根源）、胃中虚寒（胃腑本性喜凉，若长期受寒邪潜伏则成为发病根源），表现为标热本寒，且随着暑气消退、寒气初动以及新秋时节余热未清的时序变化而有所不同。治疗上，理中汤中的干姜可克制因贪凉引起的疾病，加味方剂中的大黄能清除郁结之火。但在患病初期病情尚轻时，不要急于使用上述方法，应从芍药汤中进行权衡选择。
发热如火烧般的痢疾令人担忧，可用当归四逆汤探究其本源。小柴胡汤可用于治疗伴有寒热往来的呕吐症状，仓廪汤则需要进一步深入探讨研究。
对于噤口痢（患者无法进食）这种危重病症，也是可以治疗的，但大承气汤的妙用鲜为人知。黄芩、黄连、葛根、甘草相须为用，能在短时间内打通三关，挽救危局。
真人养脏汤适用于直肠滑脱不禁（水谷直下不停止）的情况，间或配合香连丸以制止下泄趋势。仲景的桃花汤是否适用于春季？若能领悟其中道理，便可举一反三。
对于阴虚型痢疾、伴有发热及脓血黏稠的痢疾，以及休息痢（时发时止的慢性痢疾），应使用驻车丸。
千金方传承下来的驻车丸，由当归和黄连各一两半组成，重量相当；另配阿胶三两、干姜一两。这是治疗阴虚久痢的灵丹妙药。具体制法为：将阿胶三两与黄连、当归（各一两半）、炒干姜（一两）一起，用醋煮阿胶后制成丸剂。每次服用四五十丸，昼夜分三次服用，米汤送服。“三车”比喻运化精气神的功能，分别治理上、中、下三焦，以调节阴阳平衡。这是因为阳热过盛，损伤了阴精，所以用黄连来遏制“鹿车”（喻指快速运行的阳气/火）的迅猛，用干姜来鞭策“牛车”（喻指迟缓的脾胃之气）的疲乏，用阿胶来挽回陷入困境的“牛车”（喻指枯竭的阴血），用当归来调和散乱的精气神。张石顽对此的注释非常高明，此处全文引用。
奇恒痢。张隐庵说：“疾病源于外感和内伤，这是人们所共知的，但对于奇恒之病，了解的人很少。所谓‘奇恒’，就是异于平常的意思。就以奇恒之下的痢疾而言，这是三阳经邪气并至，三阴经正气难以抵挡，积滞严重则导致惊悸，风病发作迅速，脉象急迫如磨刀石般坚硬，九窍皆感寒冷，阳气旁溢，咽喉干燥堵塞。疼痛侵犯阴分，则上下无常，迫注肠道形成痢疾。其脉象缓小迟涩，若血液温热且身体发热则预后不良，若发热持续七天则死亡。这是由于阳气偏盛剧烈，阴气受损，所以脉象呈现小沉涩的特点。此证急需使用大承气汤泻除阳热以滋养阴液，若拖延则无法救治。医生如果不了解奇恒病的成因，见到脉气和缓，就使用平和的药剂，这又与毒药有什么区别呢？所以我常说：服用平和药物而痊愈的，原本就不是致命的病，不吃药也可以；服用平和汤药后反而导致不可救治的，是医生的罪过。”
Dysentery is categorized into cold and heat patterns, which differ in nature. Zhang Shi (courtesy name Xin Zai, a contemporary figure who authored *Zhang Shi Yi Can*) proposed the most refined theory regarding latent pathogens (*Fu Xie*). The pathogenesis involves intestinal heat (the intestines naturally prefer warmth; prolonged exposure to heat pathogens becomes the root of disease) and gastric cold (the stomach naturally prefers coolness; prolonged exposure to cold pathogens becomes the root of disease). This presents as superficial heat and deep cold (*Biao Re Ben Han*), varying with seasonal changes such as the retreat of summer heat, the onset of autumn chill, and the lingering residual heat in early autumn. In treatment, Ginger (*Sheng Jiang*) in Lizhong Tang can counteract diseases caused by excessive cooling, while Rhubarb (*Da Huang*) in modified formulas clears stagnant fire. However, in the early stages when the condition is mild, one should not hastily apply these methods but rather weigh options using Shaoyao Tang.
Dysentery accompanied by fever burning like fire is worrying; Daogui Sini Tang can be used to trace its origin. Xiaochaihu Tang treats vomiting accompanied by alternating chills and fever, while Canglin Tang requires further study.
Even critical cases of Jin Kou Li (dysentery where the patient cannot eat) are treatable, though the efficacy of Dachengqi Tang is rarely known. The synergistic use of Scutellariae Radix (*Huang Qin*), Coptidis Rhizoma (*Huang Lian*), Puerariae Radix (*Ge Gen*), and Glycyrrhizae Radix et Rhizoma (*Gan Cao*) can open the three passes and rescue the crisis in a short time.
Zhenshi Yangzang Tang is indicated for rectal prolapse or incontinence (where food and water pass directly without stopping), used intermittently with Xianglian Wan to stop downward flow. Does Zhongjing’s Taohua Tang apply to spring? Understanding this allows one to infer other cases from similar principles.
For Yin-deficiency dysentery, dysentery with fever and thick sticky pus and blood, as well as Xiuxi Li (intermittent chronic dysentery), Chuzhu Wan should be used.
The Chuzhu Wan passed down from the *Qianjin Fang* consists of Angelicae Sinensis Radix (*Dang Gui*) and Coptidis Rhizoma (*Huang Lian*) in equal amounts of 1.5 liang each, along with Donkey-hide Gelatin (*Ejiao*) at 3 liang and Dried Ginger (*Gan Jiang*) at 1 liang. It is a spiritual elixir for treating chronic dysentery due to Yin deficiency. Preparation: Boil Ejiao (3 liang) with vinegar together with Huang Lian, Dang Gui (each 1.5 liang), and stir-fried Gan Jiang (1 liang), then form pills. Take 40–50 pills per dose, three times day and night, washed down with rice drink. The "Three Chariots" metaphorically represent the transportation of Essence, Qi, and Spirit, governing the Upper, Middle, and Lower Jiao to regulate Yin and Yang. Because excessive Yang-heat injures Yin-essence, Huang Qin/Lian is used to restrain the rapid movement of the "Deer Chariot" (metaphor for aggressive Yang/Fire), Gan Jiang to spur the sluggish "Ox Chariot" (metaphor for Spleen/Stomach Qi), Ejiao to retrieve the stuck "Ox Chariot" (metaphor for depleted Yin-blood), and Dang Gui to harmonize the scattered Essence, Qi, and Spirit. Zhang Shiwu’s commentary on this is highly insightful and is quoted in full here.
Qi Heng Li (Strange and Constant Dysentery). Zhang Yin’an stated: "Diseases arising from external contraction and internal injury are commonly known, but few understand 'Qi Heng' diseases. 'Qi Heng' means different from the constant or normal. Taking Qi Heng diarrhea/dysentery as an example, it occurs when pathogens of the Three Yang meridians arrive simultaneously, overwhelming the Three Yin meridians. Severe accumulation leads to fright; wind diseases arise rapidly, with pulse conditions hard like grinding stones, coldness in all nine orifices, and Yang qi overflowing laterally causing dry throat and laryngeal obstruction. Pain invading the Yin aspect causes irregularity above and below, pressing into the intestines to form dysentery. The pulse is slow, small, late, and choppy. If the blood is warm and the body hot, death ensues; if heat persists for seven days, death ensues. This is because Yang qi is excessively vigorous, injuring Yin qi, hence the pulse appears small, deep, and choppy. This syndrome urgently requires Dachengqi Tang to purge Yang heat and nourish Yin; delay renders it incurable. If physicians do not understand the cause of Qi Heng disease and, seeing a moderate pulse, use mild remedies, what difference is there from poison? Therefore, I say: those cured by mild medicines originally had non-lethal diseases and could have recovered without medicine; those rendered incurable after taking mild decoctions bear the fault of the physician."